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News Scan for Apr 16, 2015

Canada reports multi-province E coli outbreak

The Public Health Agency of Canada (PHAC) has detected 12 cases of Escherichia coli O157:H7 infection in four provinces that might be linked to leafy greens, the agency said in a statement yesterday.

Nine of the cases were reported in Alberta and one each in Saskatchewan, Ontario, and Newfoundland and Labrador. Isolates from the patients have matching genetic fingerprints. Illness-onset dates range from Mar 13 to Mar 31.

Although the agency stated that "A specific product has not been identified yet, and the investigation is ongoing," it said a link to leafy greens—such as lettuce, kale, spinach, arugula, or chard—is possible. PHAC said it is collaborating with provincial authorities to monitor for and investigate any new cases.Apr 15 PHAC statement

4th US vCJD case likely involved exposure in lower-risk country

Disease exposure in the most recently confirmed case of variant Creutzfeldt-Jakob disease (vCJD) in the United States is less clear than in the three previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the country more than a decade before illness onset, researchers reported yesterday in Emerging Infectious Diseases.

vCJD is a rare neurologic disease that has no cure and is always fatal. It is related to bovine spongiform encephalopathy (BSE, or mad cow disease). The illness doesn't manifest itself until many years after infection.

US and UK investigators describe the clinical history of the patient, a Texas man in his 40s who was born in Kuwait but had lived in the United States for 14 years. Symptoms began in late 2012 with depression and anxiety that gradually worsened. Five months later, he experienced numbness and paresthesias of the left face and left arm, which was initially attributed to a recent motor vehicle accident.

From 1 year to 14 months after initial symptoms, he was hospitalized five times for psychiatric manifestations. During one of these visits, he was restless, irritable, disinhibited, and impulsive and exhibited choreiform movements (repetitive and involuntary jerky movements), most pronounced in his left arm.

Extensive investigations for infectious and autoimmune disorders were conducted, and cerebral spinal fluid was sent to the National Prion Disease Pathology Surveillance Center in Cleveland for analysis. Although tests initially came back negative for vCJD, the man was given a diagnosis of "probable vCJD." After the patient's condition deteriorated, he died last year, 18 months after symptom onset. Autopsy confirmed the diagnosis.

The patient had never stayed in the United Kingdom, France, or Saudi Arabia—the most likely countries for contracting vCJD. He had lived in Russia and Lebanon, in addition to Kuwait. The authors determined the man was most likely infected in one of those countries more than 14 years ago, given the number of years he spent there and the amount of British beef imported from the United Kingdom during that time.Apr 15 Emerg Infect Disreport